上海市2011-2015学年中小学生伤害的流行特征分析

目的 了解上海市中小学生伤害的流行病学分布特征，为制订儿童青少年伤害干预措施提供基础资料。方法 利用2011-2015学年"上海市学校因病缺课缺勤网络直报系统"中中小学生因新发伤害缺课的监测数据进行统计描述与分析。结果 上海市2011年9月~2016年6月中小学生共报告伤害事件26 061例，以男生（71.3%）为主，超九成伤害事件发生在6~10岁（41.8%）和11~15岁（48.8%）年龄组，小学一年级、初中预备班、高一年级伤害事件所占比例高于同学段其他年级，4、5月和9、10月为伤害事件多发月（54.7%）。骨折（48.1%）、脱拉/扭伤/拉伤（19.7%）和擦伤/挫伤（15.0%）是最常见的三种伤害性质，且以单一性质为主（97.1%）。各伤害性质在不同性别（χ2=193.474，P<0.001）、学段（χ2=1 349.245，P<0.001）、月份（χ2=290.992，P<0.001）的分布差异有统计学意义。男生发生骨折（49.8%vs.44.0%）、开放性伤/出血（9.6%vs.7.8%）的比例高于女生，女生发生脱拉/扭伤/拉伤（22.0%vs.18.7%）、擦伤/挫伤（16.1%vs.14.4%）的比例高于男生。随着年级的增长，骨折、擦伤/挫伤、开放性伤/出血、烧/烫伤、挤压伤占比逐渐下降；脱拉/扭伤/拉伤、肌肉肌腱劳损的构成比逐渐上升；创伤性脑损伤的构成比稳定在1.3%左右。结论 伤害的发生及其性质在不同性别、年级、月份具有不同的分布特征，应根据不同人群，在不同时间有针对性地开展健康教育并采取相应预防措施。

The epidemiology of injuries among elementary and middle school students in Shanghai from 2011 to 2015 academic year

Objective To investigate the epidemiology of injuries among elementary and middle school students in Shanghai, so as to provide basis for developing intervention strategies to reduce injuries for school-aged children.Methods Illness-induced absenteeism surveillance system was utilized to record injuries among school-aged students in Shanghai from 2011 to 2015 academic year. Epidemiological characteristics of injuries were analyzed.Results A total of 26 061 injury cases were reported from September 2011 to June 2016, most of which had only one single type (97.1%). Among all the identified cases, 71.3% involved boys, over 90% were about children whose age were between 6 and 10 years (41.8%) or between 11 and 15 years (48.8%). Over half of the cases occurred in April, May, September and October (54.7%). Freshmen in primary school, junior middle school, and senior middle school were all at higher risks compared to their counterparts in other school years. Fractures (48.1%), sprains/pulls (19.7%) and abrasions/contusions (15.0%) were the most common types of injuries. There were significant differences in the distribution of each injury type associated with gender (χ2=193.474, P<0.001), study stage (χ2=1 349.245, P<0.001) and month (χ2=290.992, P<0.001). The percentages of males with fractures (49.8% vs. 44.0%), and open wounds/hemorrhages (9.6% vs. 7.8%) exceeded those of females, while females were more likely to have sprains/pulls (22.0% vs. 18.7%), and bruises/contusions (16.1% vs. 14.4%). On the one hand, as students entered a higher grade, the proportions of fractures, bruises/contusions, open wounds/hemorrhages, scalds and crush injuries all decreased; whereas the proportions of sprains/pulls and muscle/tendon strain increased. On the other hand, the composition ratio of traumatic brain injury remained a steady level around 1.3% regardless of grade level.Conclusions Elementary and primary school students experienced different types of injuries, whose distribution varied with gender, grade level and month of the year. Health education and other preventive strategies should be implemented appropriately.